Balance billing for soft tissue injury

Submitted by Anonymous (not verified) on Sat, 02/11/2012 - 15:48

I had soft tissue injury a couple of months ago. My back, wrist and neck were injured. I went to my doctor and he referred me to a specialist in ‘bone and tissue damage’. I’m 67 years old and I’m covered by Medicare. After 2 months of alternative and chemical therapy, the specialist sent me a bill of $2,980 stating that my health coverage is only paying a part of the $3,720 bill. I thought that balance billing was illegal…I’m from AZ. Is there something I’m missing? Am I liable to pay the remainder of the bill out of my pocket? Frankly, I can’t. I’ve never been in such a situation.

Posted: 14 Feb 2012 12:50 Post Subject: Balance billing for soft tissue injury

At first you should check the coverage amount for which you have paid the premiums. If it doesn’t cover the full medical bill, then you will have to pay the remainder of the bill out of your pocket. Otherwise contact with the insurance company and ask them about this.

Posted: 14 Feb 2012 01:45 Post Subject: Balance billing for soft tissue injury

If you are covered by Medicare, then balance billing is a fraudulent practice by the insurance company.

Posted: 15 Feb 2012 06:04 Post Subject:

I thought that balance billing was illegal


Your physician is either a "Medicare-approved" provider or he is not. If he is an approved provider, he has agreed to accept Medicare's payment and your 20% coinsurance as payment in full.

If he is not an "approved" provider, he may bill up to 115% of Medicare's allowable charge, and Medicare will pay 80% of the 100% it allows, and the Medicare beneficiary pays an additional 15% of the amount considered the allowable expense.

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